| Research backgroundNeonatal necrotizing enterocolitis(NEC)is a common gastrointestinal emergency in neonates,especially in premature infants or very low birth weight(VLBW)infants.It is a dangerous complication with a rapid progress and a high mortality,which seriously threatens neonates.In recent years,large number of studies showed that NEC are associated with preterm birth,inappropriate feeding,infection,hypoxic-ischemia,anemia,blood transfusion,and immunodeficiency.However,the relationship between anemia,blood transfusion and NEC is still controversial.It is generally believed that red blood cell(RBC)transfusion increases the risk of NEC,but some studies have shown that severe anemia rather than blood transfusion can lead to NEC.Some studies even showed that RBC transfusion has a protective effect on NEC.Thus,further study focusing on the correlation between severe anemia,RBC transfusion and NEC is necessary.It has important guiding significance for the clinical standardization of blood transfusion treatment strategies and early identification and prevention of NEC.ObjectiveTo observe the clinical features and prognosis of NEC in neonates with different birth weights,and to explore the correlation between severe anemia,RBC transfusion and NEC.MethodsThe clinical data of newborns with stage II-III NEC who were admitted to our hospital from January 2012 to July 2020 were retrospectively collected.According to different birth weight,they were divided into three groups(<1500g,1500-2499 g and≥2500g).Clinical features and outcomes of NEC were observed.A retrospective case-control study was conducted in VLBW infants(<1500g).Non-NEC infants were matched with the same gestational age(±3 days),birth weight(± 200g)and gender as1:1 ratio in the study period.Univariate and multivariate analyses were used to investigate the relationship between severe anemia,RBC transfusion and NEC.Results1.The age of NEC onset was 13.0(4.0,24.0)d in the birth weight <1500g group,7.0(4.0,10.0)d in the birth weight 1500-2499 g group,and 3.0(3.0,5.5)d in the birth weight ≥2500g group.With the decrease of gestational age and birth weight,the age of NEC onset was gradually prolonged(P<0.05).2.Compared with the 1500-2499 g group and ≥2500g group,abdominal distension [(153/166,92.17%)vs.(185/232,79.74%),(53/69,76.81%)] and apnea[(86/166,51.81%)vs.(43/232,18.53%),(1/69,1.45%)of NEC infants in the <1500g group were higher,the incidence of bloody stools was lower [(50/166,30.12%)vs.(152/232,65.52%),(52/69,75.36%)],and the differences were statistically significant(P<0.05).3.The incidence of thrombocytopenia after NEC onset in the <1500g group(30.12%)was significantly higher than that in the other two groups(16.81% in the1500-2499 g group,10.14% in the ≥2500g group)(P<0.05),and the mortality rate was the significantly highest(20.48% in the <1500g group,8.19% in the 1500-2499 g group,and 2.90% in the ≥2500g group)(P<0.05).4.In VLBW infants,univariate analysis showed that the percentage of RBC transfusion within 48 h before NEC onset was significantly higher in NEC group than in control group(16/166,9.64% vs.3/188,1.81%)(P<0.05).The incidence of severe anemia was also higher than that in the control group(39/166,23.49% vs.30/166,18.07%),but the difference was not statistically significant(P>0.05).Multivariate analysis showed an increased risk of NEC within 48 hours after RBC transfusion(OR=5.587,95%CI:1.568-19.907,P=0.008).5.Logistic regression analysis showed that placental abruption(OR=3.546,95%CI:1.338-9.399,P=0.011)and umbilical vein catheterization(UVC)or peripherally inserted central catheter(PICC)(OR=1.945,95%CI:1.237-3.060,P=0.004)were risk factors for NEC in VLBW infants.Conclusions1.In VLBW infants,there was an increased risk of NEC within 48 hours after RBC transfusion.2.There is no correlation between severe anemia and NEC in VLBW infants.3.Placental abruption and UVC or PICC were risk factors for NEC in VLBW infants. |
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